Validation of chronic kidney disease risk categorization system in Chinese patients with kidney disease: A cohort study

AimTo validate the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines risk stratification system based on the combination of estimated glomerular filtration rate (eGFR) and proteinuria. MethodsThis was a cohort study. A total of 1219 study population were recruited. Estimated GFR and proteinuria measured by using 24 h urine protein excretion rate (PER) were predictors. Adverse outcomes included all-cause mortality (ACM) and end-stage renal disease (ESRD). Follow-up was done by regular visit, telephone interview and electronic medical records. ResultsOver a median follow-up of 4.6 years, 153 (12.6%) and 43 (3.5%) patients experienced ESRD and ACM, respectively. On multivariable analysis, the adjusted hazard ratio for ESRD and ACM (compared with patients with eGFR>60mL/min per 1.73m(2)) was of 29.8 and 3.6 for those with eGFR of 15-29mL/min per 1.73m(2), respectively. The adjusted hazard ratio for ESRD and ACM (compared with patients with PER<150mg/24h) was of 15.9 and 3.9 for those with PER>500mg/24h. Higher KDIGO guidelines risk categories (indicating lower eGFR or higher proteinuria) were associated with a graded increase in the risk for the ESRD (P<0.001) and ACM (P<0.001). Reclassification of KDIGO guidelines risk categories yielded net reclassification improvements for those with ESRD or ACM event (NRIevents) of 33.3% or 30.2%. ConclusionLower eGFR and higher proteinuria are risk factors for ESRD and ACM in Chinese patients. The KDIGO guidelines risk categorization system assigned patients who went on to have the event to more appropriate CKD risk categories. Summary at a Glance This paper provides a validation of the KDIGO risk stratification in a Chinese population living in China, based on a combination of eGFR and proteinuria.